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IBD IN 2018

New approaches along the IBD course: diet, tight control and stem cells

Nature Reviews Gastroenterology & Hepatology volume 16, pages 82–84 (2019)Cite this article

Subjects

Important studies published in 2018 highlight novel therapeutic strategies along the disease course of IBD, including potential specific dietary modifications at early stages and treatment with adipose-derived stem cells in perianal Crohn’s disease. A treat-to-target approach that involves proactive serial monitoring of inflammatory biomarkers can assist in timely treatment escalation and promises improved patient outcomes.

Key advances

  • Specific mixtures of macronutrients and emulsifiers within the diet affect intestinal permeability, gut microbiota density and predispose to intestinal inflammation in IBD2

  • Allogeneic expanded adipose-derived stem cells result in long-term clinical and radiological healing in patients with treatment-refractory perianal Crohn’s disease3

  • An approach of tight control, using faecal calprotectin and C-reactive protein measurements to guide treatment escalation, resulted in improved endoscopic and clinical outcomes in patients with Crohn’s disease4

Traditional pharmacological therapies stem from initial identification of inflammatory pathways in preclinical models and patients, followed by development of small molecules or monoclonal antibodies to neutralize these pathways, eventually leading to randomized controlled trials of efficacy and routine clinical use. Diet has long been purported to have a role in intestinal inflammation, but the field of dietary therapy for IBD has remained nascent despite the discovery of several plausible mechanisms through which dietary constituents can modulate intestinal inflammation and immune responses. Elimination diets showed variable efficacy in case series and only limited experimental evidence supports the rationale for specific dietary inclusions and exclusions.

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Fig. 1: New targets and strategies along the course of IBD.

References

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Acknowledgements

The authors thank Whitney Tang for assistance with preparing the figure.

Author information

Authors and Affiliations

  1. Department of Medicine and Therapeutics, Institute of Digestive Disease, Li Ka Shing Institute of Health Science, State Key Laboratory of Digestive Disease, The Chinese University of Hong Kong, Hong Kong, China

    Siew C. Ng

  2. Division of Gastroenterology and Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA

    Ashwin N. Ananthakrishnan

Authors
  1. Siew C. Ng
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  2. Ashwin N. Ananthakrishnan
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Corresponding author

Correspondence to Siew C. Ng.

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Competing interests

S.C.N. has received consulting and speaker fees from AbbVie, Ferring, Janssen, Menarini and Takeda, served as a Scientific Advisory Board member for AbbVie, Ferring and Takeda and received research grants from AbbVie, Ferring and Janssen. A.N.A. has served as a Scientific Advisory Board member for Abbvie and Gilead and received research grants from Pfizer and Merck.

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Ng, S.C., Ananthakrishnan, A.N. New approaches along the IBD course: diet, tight control and stem cells. Nat Rev Gastroenterol Hepatol 16, 82–84 (2019). https://doi.org/10.1038/s41575-018-0088-4

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  • DOI: https://doi.org/10.1038/s41575-018-0088-4

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